• Editors' Summary
• Credits

1. Why Informed Choice Matters
2. Making Family Planing Decisions
3. Policies for Informed Choice
4. Communication for Choice
5. Improving Access
• More Methods Mean More Choices
• Offering More Sources
6. Managing for Informed Choice
7. Client-Provider Communication

• Figures
• Table
• Side-bars
• Bibliography

• What can be done?
• Women know what they want
• Why communities matter
• Eliminating targets
• More methods, more choices
• "Your health is in your hands"
• Do clients have choices?
• Please Ask!
• How much guidance?
• Active clients, better choices
• Counseling continuing clients

• POPLINE
• Media/Materials Clearinghouse
• Other Reports
• To Order
• CCP Home Page

Published by the Population Information Porgram, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

Broadening the types of service delivery can provide more choices, especially for people whom conventional programs have difficulty serving (327). These include people with low incomes, those in rural areas, women who cannot leave their homes, and others who want their contraceptive use to remain private (335, 395). In addition, with more service delivery outlets, people who want a particular contraceptive—for example, a specific brand of condom or pill formulation—can more easily find it.

Many people base their choice of family planning on how accessible a method is—particularly if visiting a clinic requires long travel (160). A nearby source can even make the difference between using contraception and not using it at all. In Morocco, for example, a survey of women who in 1992 had not intended to use contraception found that by 1995 those who lived close to a hospital, clinic, doctor, or pharmacy were more likely to be using family planning than those who lived farther away. While such other factors as social and economic differences or changes in reproductive intentions could explain the difference, the researchers concluded that proximity to a source of supply was the most likely reason (276).

Programs can offer methods through community-based distribution, social marketing, and private providers, as well as through family planning clinics and hospitals. In CBD programs fieldworkers visit each household in the community or use community organizations and institutions to offer contraceptives (16, 323).

Although CBD can be expensive to sustain (217), it expands family planning choices by bringing contraceptive methods to people rather than requiring people to visit clinics or pharmacies (197). CBD can be especially helpful if CBD agents are trained to give contraceptive injections safely, thereby increasing the method choices they can offer (337). CBD agents, however, cannot be effective counselors if they prefer to offer only methods that they can provide immediately and so stress supply methods over methods involving referral (244).

Population Services International A pharmacist in Cambodia demonstrates how to use a condom correctly. When pharmacists and other private providers are trained to offer detailed information on correct use of family planning methods, they can help their customers use their chosen method more effectively.

Contraceptive social marketing—the promotion and sale of family planning methods at subsidized prices—can improve access by making contraceptives better known, more affordable, and widely available through shops, pharmacies, and other retail outlets. Social marketing programs typically offer condoms, pills, and spermicides and have proved particularly successful at marketing condoms for STI prevention (108, 135, 375).

For the most part, social marketing programs are designed to promote specific contraceptives, not to ensure information about and access to a range of methods. For this reason some have argued that social marketing programs—no matter how well-intentioned—inevitably bias people's family planning choices (335). Increasingly, social marketing programs are training pharmacists, shopkeepers, community health workers, and others who sell social marketing brands to provide clients with more information about family planning choices (11, 126). Social marketing programs can encourage retailers to discuss the range of methods with customers and to offer information about safety and instructions for proper contraceptive use (17, 148, 334).

Pharmacies, private-practice physicians, and other private-sector providers are a growing source of family planning supplies and services (238, 270). In developing countries the commercial sector serves 20% of women who use modern contraceptive methods (390). In some countries people say that private family planning services offer better quality than public services, and people are increasingly able and willing to pay the full price of services (47, 390, 417).